Healthcare Provider Details

I. General information

NPI: 1386795656
Provider Name (Legal Business Name): CASTLE ROCK FAMILY PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S PERRY ST SUITE 100
CASTLE ROCK CO
80104-1901
US

IV. Provider business mailing address

755 S PERRY ST SUITE 100
CASTLE ROCK CO
80104-1901
US

V. Phone/Fax

Practice location:
  • Phone: 303-688-8989
  • Fax: 303-688-3482
Mailing address:
  • Phone: 303-688-8989
  • Fax: 303-688-3482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28038
License Number StateCO

VIII. Authorized Official

Name: DR. LOUIS BAIRD KASUNIC
Title or Position: PRESIDENT
Credential: DO
Phone: 303-688-8989